The Stress and Adversity Inventory for Adolescents (Adolescent STRAIN): associations with mental and physical health, risky behaviors, and psychiatric diagnoses in youth seeking treatment

J Child Psychol Psychiatry. 2019 Sep;60(9):998-1009. doi: 10.1111/jcpp.13038. Epub 2019 Mar 26.


Background: Numerous theories have posited that stressors occurring over the lifespan may exert a cumulative effect on psychological and biological processes that increase individuals' risk for a variety of mental and physical health problems. Given the difficulty associated with assessing lifetime stress exposure, however, few empirical studies have directly tested these cumulative risk models of psychopathology and human health.

Method: To address this issue, we examined the usability, acceptability, concurrent validity, and predictive validity of the recently developed Stress and Adversity Inventory for Adolescents (Adolescent STRAIN) in 338 youth (Mage = 15.64; 229 females) seeking mental health treatment.

Results: The Adolescent STRAIN achieved high acceptability and was completed in approximately 25 min (interquartile range: 20-32 min). Concurrent associations with other measures of early adversity (Childhood Trauma Questionnaire-Short Form) and interpersonal stress (Revised Peer Experiences Questionnaire) were very good (rs = .50-.59). In analyses that adjusted for participants' age, sex, and race, the STRAIN was significantly associated with depression, anxiety, and anhedonia severity; general mental and physical health complaints; risky behavior engagement; and number of interviewer-based psychiatric diagnoses (βs = .16-.52; risk ratios = 1.006-1.014). Contrary to classic theories of stress which assume that different stressors exert similar effects on health, substantial differences were observed across the two stressor types, twelve life domains, and five core social-psychological characteristics assessed by the Adolescent STRAIN.

Conclusions: These data confirm the relevance of lifetime stress exposure for multiple health outcomes in adolescence, which can in turn inform existing theories of lifespan health. Because stress is a common presenting problem in hospitals and clinics, these data also suggest the possibility of using the Adolescent STRAIN to generate stress exposure profiles for case conceptualization and treatment planning purposes.

Keywords: Life stress; adolescence; assessment; health; psychopathology.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adolescent Behavior*
  • Adult
  • Adverse Childhood Experiences*
  • Behavioral Symptoms / diagnosis*
  • Child Abuse*
  • Female
  • Humans
  • Male
  • Mental Disorders / diagnosis*
  • Psychiatric Status Rating Scales / standards*
  • Reproducibility of Results
  • Stress, Psychological / diagnosis*
  • Young Adult